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Shallow, painful latch with 34-weeker who just reached term

My baby boy was born at 34 weeks. I had planned to breastfeed, but was not very educated about it. He was in the NICU for two weeks. I was encouraged to pump to get my milk supply started from the start, which I did and my baby was fed my milk in a bottle. Pumping has been very hard. It was quite uncomfortable from the start and caused pain on my right nipple. I tried breastfeeding a few times while he was in the NICU, always with a nipple shield. Since he got home, I've been practicing breastfeeding as much as I can manage. I desperately want to switch to exculsive breastfeeding, but it's so difficult when I'm pumping all the time and for some reason I'm so scared to breastfeed. I lack the confidence. I just don't think I'll be able to do it.

Well, I've seen countless lactation consultants and I've been trying to breastfeed more and more. When I see a consultant they are usually really encouraging and tell me I'm doing well. Baby seems to latch fairly well when I'm with the lactation consultants, but when I get home I can't seem to recreate that experience and I get so discouraged and frustrated. Bottom line is that I can't seem to get a deep enough latch. I always feel a painful pinch throughout the whole feeding and the right side is especially painful. My nipple also often has a lipstick shape when he comes off. I think he just doesn't open wide enough. I must admit that I don't wait for him to open wide anymore, because he just never seems to open very wide at all, so I would be waiting forever. I usually just plop him on when he opens up and then just deal with the pain. I don't unlatch him and relatch unless the pain is worse than normal. I just don't see the point because I've never been able to achieve an unpainful latch, so it seems like an unnecessary and fruitless struggle. Maybe I need to try harder, but I'm so exhausted from this whole process and I just want this to click. I want to breastfeed him so badly! I'm not sure what to do. I can handle the pain, but I'm scared that it will get worse (nipples will get cracked and bloody). If the pain were to continue as is I think I could handle it. Is it possible it could just get better with time? (When my nipples toughen up and his mouth gets bigger??)

Re: Shallow, painful latch with 34-weeker who just reached t

And I should mention that I'm no longer using the nipple shield. One lactation consultant suggested trying without and he was able to latch on (but it's still shallow). I have very large breasts and fairly flat nipples.

Re: Shallow, painful latch with 34-weeker who just reached t

Hi Sanyabee, welcome to the forum and congratulations on your new baby.

It would help a little if we had some details- I am not sure what you mean-is baby 6 weeks old now (actual, not adjusted?) Is baby exclusively fed with your milk or formula as well? Baby gaining as he should? What positions/latch techniques have you tried? Are bottle feedings small and frequent? Has tongue tie been ruled out? Are you glad to be rid of the shields, or do you think they were helping? Are you pumping on a schedule, (for example, every three hours) or aiming for a certain number of sessions per day but not a set schedule? (The latter can feel more doable.) Was there one LC you thought helped you the most? Are you keeping in touch with them?

So, some of what you describe is very common, such as the fear you will not be able to breastfeed, and nursing session going fine at the LC and then not at home. I do not know why this happens, but I suspect it is part of the same problem as the lack of confidence. A newborn baby is very small and (you may feel) fragile. Maybe you are less comfortable trying new things, play around with positions, etc, as you might feel when with an LC. Does that sound like it might be part of your experience?

I am not of the opinion that the best course of action is to always relatch baby if the latch hurts. I agree with you, it sometimes seems pointless. Some babies really do not gape. If you are trying the usual things that might trigger gape (nipple to cheek, nipple brushing lips, brushing lip over upper lip and down to go into mouth, nursing laid back, encouraging baby to more or less self attach) and none of that is working, and baby still latches shallowly, even with an assisted latch (like a breast sandwich,) I think you can also try adjustments after latching baby.

Sometimes just moving baby's bottom around to adjust the angle of the latch (such as, pulling baby's bottom more into you) can help. Baby is so small that pulling bottom in to your body angles the chin in and nose out for that asymmetric type latch. Or you can try gently pulling on baby’s lips or jaw to try to get baby's mouth more open/taking in more breast tissue, or gently pressing more of your breast tissue into baby's mouth. It will take some experimentation to figure out what will work for you and your baby. This is where the confidence comes in. A LC and any other breastfeeding helper can only take you so far, and then the rest is up to you and baby learning each other. I would not say you need to try HARDER, obviously you are already trying so hard. I do think it would help to build up your confidence over all. This can be very hard in any situation, and particularly difficult when baby was born early, and/or, needed longer hospitalization or supplements. Do you have any breastfeeding supprt groups near you? These can be vital for a mom trying to build her confidence.

As far as nipple pain goes, yes, you want to avoid reinjury. What is happening now? scabbing, healed, something else?

Also your pump should NOT hurt you. What is going on there do you think? Too small flange maybe? (sometimes you need a different size on each breast) pumping at too high a setting?

I want to breastfeed him so badly!

You ARE breastfeeding. Your baby is getting your milk, sometimes even directly from you! I have talked to many new moms and where you are at right now really is great and encouraging after such a rough beginning. This is a great base from which to build.

Re: Shallow, painful latch with 34-weeker who just reached t

Hello lllmeg and thank you so much for your reply!

In response to your questions, baby is now 6 and half weeks actual (not adjusted). He was born on October 16th and was due November 24th. He has been fed my breast milk exclusively, although for a couple weeks I was fortifying my milk with some formula to give him some extra calories and help him gain weight (per doctor's orders). He has been gaining weight VERY well. He was born at 5 pounds, 10 onces, and is now 8 pounds 12 ounces. Weight gain is no longer a concern. In fact, I wonder if I feed him too much milk. With the bottle, he seems to just keep drinking more and more and I'm not sure if I should put a cap on how much he gets. His doctor said that I shouldn't worry about it, but I still wonder and worry about his poor little tummy when he drinks a bunch.

So, bottle feedings are about every 3 hours and they are usually quite large (he usually takes anywhere from 60 to 90 millileters, but sometimes even up to 130). I've tried feeding him more on demand, but he doesn't seem to wake up and ask to eat very often. He'll usually go longer than 3 hours without asking for anything. He doesn't cry and I think this might be a preemie thing. Maybe he will start crying more soon. Anyways, I would like to transition him off of this strict 3-hour schedule, because I know it's not normal for a newborn, but I'm not sure how to, since he goes so long without eating if I leave it up to him.

I have tried the cross cradle position, the football hold and the cradle position. I have also tried laid back nursing (not very seriously, though). I had no luck with that and thought it quite difficult to control baby's head and latch while lying back. With the cross cradle, I sandwich my breast with a u-hold, tickle his upper lip with my nipple and then try to flip my nipple down into his mouth and push him on when he opens. Recently I've started trying the cradle hold after a lactation consultant suggested it. I use the arm that is not supporting his head to pinch the outer edges of my areola inwards (using my pointer and middle fingers) to make a sort of sandwich from above. Then I try to push his lower lip down with my sandwich and then push the sandwich and nipple into his mouth. I guess the point of this is to try to get his lower lip to curl out. I have a hard time with this method though and usually can't get a decent latch at all without a helper to push his head on for me. I haven't done the football hold very many times. You were right when you said that I'm probably scared to experiment. I am. I don't want baby to get frustrated and I lack confidence. I think you were also spot on when you said that I might do better with a lactation consultant simply because I feel more confident and relaxed in their presence. For some reason I'm scared to breastfeed on my own, and when I'm home I like to have someone with me when I do it.

Tongue tie has not been ruled out and baby is supposed to see a occupational therapist/physical therapist feeding specialist on December 11th, and I assume that they will check for that.

I am glad to be rid of the shields. They were just so inconvenient to use and I don't think they were helping, although I've contemplated trying them again on my right side, because that side is just so painful. Right now when I breastfeed I almost always do so on the left side exclusively, because I'm just so scared to put him on the right side. The right side has been bothered by the pump from the beginning. For some reason the breast tissue surrounding the nipple would always get sucked up into the tubing, causing me to have a puffy swollen ring around the nipple at the end of my pumping sessions. I tried every size flange and they all seemed to do the same thing. I've also tried decreasing the suction, but nothing seems to make much of a difference. There's just something funky about that breast and how it fits with the pump (I'm using the medela symphony). I've gotten used to the pump and it doesn't bother me so much anymore, but I do believe that it's possible that pumping has caused some nipple damage and is contributing to my pain when I breastfeed. My nipples are unusually pink and tender. The right nipple looks swollen and more pink than the left. I've wondered whether I could have thrush and have started using some ointment for that, so we'll see if my body responds. I haven't had any cracking or bleeding, but worry that I might if I keep breastfeeding with a shallow latch.

I am not pumping on a schedule. I generally pump every 3-4 hours (lately it's been about every 4 hours more consistently). Sometimes I unintentionally go longer between pumps. I was pumping more at the beginning, but now I have such a large supply and I also breastfeed a couple times a day, so I worry less about how often I pump. In fact, I think I might have an issue with oversupply. I have been pumping almost twice as much as my baby drinks. The last couple of days, he's been breastfeeding better (staying on the breast for longer and not accepting a supplement in the bottle afterwards) and I have noticed that he has been having green watery stools. I've read this could be caused by a foremilk/hindmilk imbalance? Now I'm wondering how I should decrease my supply to match his needs better. Should I pump less often or just for less time at each session?

Again, thank you so much for your help! There are some breastfeeding support groups near me, and I've been a bit reluctant to go, because I thought that most moms would be dealing with different issues than me, since my baby was premature and I couldn't start breastfeeding when he was born. However, perhaps I should try one out. Thank you for the suggestion and for all the encouragement.

Re: Shallow, painful latch with 34-weeker who just reached t

With the bottle, he seems to just keep drinking more and more and I'm not sure if I should put a cap on how much he gets.

So, bottle feedings are about every 3 hours and they are usually quite large (he usually takes anywhere from 60 to 90 milliliters, but sometimes even up to 130).

are you using paced bottle feeding techniques? This allows baby to have more control of the feeding and helps prevent overfeeding.

He'll usually go longer than 3 hours without asking for anything. He doesn't cry and I think this might be a preemie thing.

Crying is a late sign of hunger. Babies will typically cue to eat, long before they cry. Baby will cue (and often can nurse) even in sleep. Is baby typically being held by you or usually sleeping in his own crib or similar? Are you doing skin to skin time? Is baby given a pacifier or swaddled?

The right side has been bothered by the pump from the beginning. For some reason the breast tissue surrounding the nipple would always get sucked up into the tubing, causing me to have a puffy swollen ring around the nipple at the end of my pumping sessions.

The nipple is supposed to get sucked into the tubing (I assume you mean the tunnel) and move in and out freely with the air flow. So do you mean, your areola is getting sucked into the tunnel, or do you mean your nipple is rubbing on the sides of the tunnel? The former would mean the flange is too large for your breast and the latter that the flange is too small. Either will cause breast injury! This does matter! No wonder it hurts! Did any of the LCs you saw ever watch you pump?

I have noticed that he has been having green watery stools. I've read this could be caused by a foremilk/hindmilk imbalance? Now I'm wondering how I should decrease my supply to match his needs better. Should I pump less often or just for less time at each session?

PLEASE do not worry about this. This is a non-issue. Lets get baby nursing. Once baby is exclusively nursing , you will no longer need to pump at all, and your production will regulate. Meanwhile, since you have a great production, lets keep it that way. I would suggest 1) Nurse more often, which would allow you to pump less often, & maybe pump for a shorter length of time, but not less often UNLESS baby is nursing more often.

There are some breastfeeding support groups near me, and I've been a bit reluctant to go, because I thought that most moms would be dealing with different issues than me, since my baby was premature and I couldn't start breastfeeding when he was born. However, perhaps I should try one out.

even if your issues were unusual, it would be important to get support. But they are not. Your major issue right now is painful latch, wouldn't you agree? And that is probably the MOST common breastfeeding issue.

I strongly urge you to keep trying laid back. I will post more about this position in another post.

Did you ever see an IBCLC (board certified LC) for a complete (1-2 hour) one on one consult? Has ANYONE looked in your baby's mouth? Watched baby nurse, watched you pump? this is very important! An IBCLC cannot 'officially' diagnose tt but she can certainly suspect it. Many doctors are not yet aware/agree with the issue of tt and it's very negative affect on breastfeeding. I strongly urge you to, if possible, see someone who knows about this issue asap to rule out (or treat) this physical cause of painful breastfeeding.

Ok. I wrote a lot and even I am tired, and I do not have a newborn! Please let me know if you would like some clarification on anything!

Re: Shallow, painful latch with 34-weeker who just reached t

Laid back position http://www.llli.org/docs/00000000000...astfeeding.pdf This picture shows ONE WAY to do laid back. You can do it much LESS laid back, and baby can be in any position. You can try latching baby first, and then relaxing back to a slightly reclined position. There is an endless variety of what to try, and if baby is calm when brought to the breast, baby will be more willing to try something new. I suggest, while you can help baby all you need, try to not manipulate baby’s head too much, or press on the back of baby’s head when baby is latching on or nursing. Your baby is stronger than you think. My daughter was born at 37 weeks via c-section, and one hour after birth I was holding her on my chest in a laid back position and she pushed herself up with her arms and plopped herself onto my nipple and latched right on. This is not unusual; this is typical for when baby’s latch in this position. (Although of course it is fine to help baby as needed.) My point is, your baby is stronger than you think.

Here are two simple pictorials, one on latch, one on tongue tie. In the one on latch, Notice that the mother is in a “slightly” laid back position, looks like on a couch? This is a very “adjustable” position, play around to find how you and your baby are most comfortable. http://cwgenna.com/quickhelp.html

Re: Shallow, painful latch with 34-weeker who just reached t

Thank you so much for your help and I'm sorry it has taken me so long to respond. It's hard sometimes to find the time and energy to write on this forum.

"are you using paced bottle feeding techniques?"

No, I am not using paced bottle feeding techniques. I do take frequent burps to break and to see if he wants more or is just sucking. Thank you for the information.

" Is baby typically being held by you or usually sleeping in his own crib or similar? Are you doing skin to skin time? Is baby given a pacifier or swaddled?"]

Baby is held by me part of the time and sometimes he is in a co-sleeper. It's hard to be with him all the time when I have to pump and eat, etc. I check on him constantly when I'm not with him. He's never alone for more than five minutes or so. I tend to feed him on a schedule of every three hours, but I feed him sooner if he is showing clear signs of hunger. This schedule has stuck from when he was in the NICU. I know it's not natural for a baby to be on a schedule, but it seems that all of us are just used to it (including baby, I think).

I have not been doing skin to skin time. Again, I find it a bit complicated when I have to get up and pump constantly. And I don't want him in just a diaper if he's not doing skin to skin and I don't want to be constantly taking his clothes on and off, because I don't want to disturb him when he's sleeping. Should I be doing skin to skin time? Do you have suggestions of how to make it work?

Baby is given a pacifier quite often. He was given a pacifier in the NICU and we've been giving it to him ever since. Baby is rarely swaddled.

"So do you mean, your areola is getting sucked into the tunnel, or do you mean your nipple is rubbing on the sides of the tunnel? The former would mean the flange is too large for your breast and the latter that the flange is too small. Either will cause breast injury! This does matter! No wonder it hurts! Did any of the LCs you saw ever watch you pump?"

This is difficult to answer and I've been asked this before. My nipples are fairly small and flat and it's hard to tell where they end and where my areola begin. But I'm pretty sure that more of the areola is getting sucked up. I have mentioned this to countless lactation consultants and some have seen me pump. Every consultant would say something different (some said I needed bigger flanges and some said I needed smaller ones). I tried every size that Medela makes and all of them seemed to do more or less the same thing and cause me to be a bit swollen on the right side. I've given up on finding a solution. My breast must just be strange. Once lactation consultant suggested trying a PJ's Comfort pump, which has soft silicone flanges. She said it might be more comfortable for me. Right now I'm looking into getting one through my insurance.

"Did you ever see an IBCLC (board certified LC) for a complete (1-2 hour) one on one consult? Has ANYONE looked in your baby's mouth? Watched baby nurse, watched you pump?"

I have seen lactation consultants through the Swedish Hospital Lytle Center here in Seattle. I don't know if any of them were board certified. I had a couple 1.5 hour long consultations and they helped me nurse. But like I said before, when I get home I usually can't figure out how to do what they showed me in the appointment. It just doesn't work as well and I get quite frustrated. Noone has looked in my baby's mouth. One lactation consultant stuck her finger in his mouth and felt him suck. She said he had a tight such and he would occasionally move his tongue from where it should be and sort of chomp down on her finger. I think that's what he does to my nipple.

Re: Shallow, painful latch with 34-weeker who just reached t

By the way, I tried to put quotes from your post, like you did, but I couldn't figure out how to do it.

One other question. The other night, it seemed to me that baby magically latched on. I didn't do anything differently. I held him in cross cradle and sandwiched my nipple. He latched on and it didn't hurt. It looked like he was sucking more of my breast tissue up into his mouth. This was after I had given him a full bottle (of 90 mil, which is what he normally takes). He was acting hungry still so I put him to the breast and he just latched on and it didn't hurt. I was overjoyed. However, he hasn't done that since. It seems his latch is slightly less painful than it used to be, but not as good as the other night. Why might this be? Any thoughts?? Is it possible for baby to suddenly just figure out how to latch correctly on his own??